The region leads the developing world in levels of antiretroviral coverage, yet challenges remain, says new PAHO/WHO report
Washington, D.C., 27 November 2013 (PAHO/WHO) — Three out of four people who need antiretroviral treatment (ART) in Latin America and the Caribbean are receiving it, according to a new report from the Pan American Health Organization/World Health Organization (PAHO/WHO). That leaves one in four without the life-saving treatment but represents a 10% improvement in just two years and puts Latin America and the Caribbean ahead of all other developing regions in levels of ART coverage.
“Latin America and the Caribbean lead the world in providing and expanding antiretroviral treatment on the basis of technological innovation and scientific evidence,” writes PAHO Director Carissa F. Etienne in the preface to the report, Antiretroviral Treatment in the Spotlight: a Public Health Analysis in Latin America and the Caribbean 2013. “What remains is to close the gap in treatment coverage and ensure equitable access to and delivery of services,” writes Etienne.
The report is the second in a series and compares data from 2010 with more recent data. It shows that, since 2010, countries in Latin America and the Caribbean have continued to expand access to ART, and many are close to bridging the remaining gaps in coverage. As of December 2012, 725,000 people were receiving ART in the region, or 75% of the total number estimated to be in need treatment according to 2010 PAHO/WHO guidelines. Seven countries had achieved universal (over 80%) ART coverage: Argentina, Barbados, Brazil, Chile, Cuba, Guyana, and Mexico. Eleven others were close to achieving it, with coverage approaching or exceeding 70%: Bahamas, Belize, Costa Rica, Jamaica, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Trinidad and Tobago, and Venezuela.
The report also shows progress by the countries in following PAHO/WHO recommendations for optimizing ART regimens. As of 2012, 78% of adults receiving first-line ART were using WHO’s evidence-based recommended first-line treatment regimen. In contrast, only 39% of patients in second-line treatment were using the recommended regimens. Just 4% of patients were receiving obsolete or inappropriate drugs, down from 7% in 2010.
Seven countries in the region—Argentina, Belize, Bolivia, Brazil, Costa Rica, Ecuador and Honduras—are now following WHO recommendations to provide ART at an earlier stage of HIV infection (CD4 count under 500 cells/mm3) both to improve patient outcomes and to reduce transmission. Eight other countries are expected to adopt the new guidelines in the near future. Meanwhile, Brazil has announced that it plans soon to adopt a “test-and-treat” policy under which it will offer ART to anyone diagnosed with HIV, regardless of CD4 count.
The report also points to progress by countries in reducing their dependence on external financing for ART. In 26 of 42 countries and territories analyzed, HIV services were being financed with domestic resources. However, 10 countries remained “highly dependent” on external financing for ART.
Other findings in the report include:
• On average, 75% of countries’ budgets for HIV care and treatment is allocated to the purchase of ART.
• In 2012, 14 of 31 countries and territories, or 45%, reported at least one stock-out (shortage of ART drugs), down from 54% in 2010.
• The prices paid by different countries for ART vary significantly. Some countries are paying as much as 77 times what others pay for the same medication.
• Of the 725,000 people receiving ART in Latin America and the Caribbean, approximately 26,900 are children under age 15.
• Rates of ART coverage are lower for children, with 67% of those who need treatment receiving it, compared with 75% of adults.
• In half the countries studied, 40% or more of patients had already developed AIDS (<200 CD4 cells/mm3) at the time of their first immunological assessment.
• Laboratory monitoring of patients receiving ART improved, with an increase of 33% in the median number of viral-load examinations per patient per year since 2010.
• Half of countries report having standards for community participation in the delivery of HIV care and treatment.
To sustain the region’s relatively high levels of ART coverage and accelerate progress toward universal coverage, PAHO/WHO has been working with member countries to increase the efficiency, effectiveness, and sustainability of ART programs. The framework for these efforts is “Treatment 2.0,” a joint initiative of PAHO/WHO and UNAIDS that focuses on expanded HIV testing and counseling, improved patient referrals, optimization of drug regimens, maximization of patient adherence, community participation, and monitoring of patient viral loads.
The 2013 edition of Antiretroviral Treatment in the Spotlight: a Public Health Analysis in Latin America and the Caribbean was prepared with support from partners including the Horizontal Technical Cooperation Group of Latin America and the Caribbean and civil society networks.
World AIDS Day is celebrated on 1 December every year to raise awareness about HIV/AIDS and to demonstrate international solidarity in the face of the pandemic. The day is an opportunity for public and private partners to disseminate information about the status of the pandemic and to encourage progress in HIV/AIDS prevention, treatment, and care around the world, particularly in high-prevalence countries.
PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It serves as the Regional Office for the Americas of WHO and is part of the Inter-American system.
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